Healthcare Provider Details

I. General information

NPI: 1760157085
Provider Name (Legal Business Name): CAMILLE JUCUTAN COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6090 ROYALTON RD # 190
NORTH ROYALTON OH
44133-5104
US

IV. Provider business mailing address

6090 ROYALTON RD # 190
NORTH ROYALTON OH
44133-5104
US

V. Phone/Fax

Practice location:
  • Phone: 330-998-5392
  • Fax:
Mailing address:
  • Phone: 330-998-5392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA009010
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: